脾脏联合胰尾切除在上皮性卵巢癌肿瘤细胞减灭术中的临床观察  

Clinical observation of splenectomy with distal pancreatectomy during cytoreductive surgery in epithelial ovarian cancer

作　　者：刘艺璇 闫倩倩 陈雨莲 周颖[2] 江榕 LIU Yi-xuan;YAN Qian-qian;CHEN Yu-lian;ZHOU Ying;JIANG Rong(Department of Gynecologic Oncology,Zhongshan Hospital,Fudan University,Shanghai 200032;Department of Obstetrics and Gynecology/Core Facility Center for Medical Sciences,the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,Anhui Province,China)

机构地区：[1]复旦大学附属中山医院妇科肿瘤科,上海200032 [2]中国科学技术大学附属第一医院(安徽省立医院)妇产科/公共科研平台,合肥230001

出　　处：《复旦学报（医学版）》2024年第1期50-55,共6页Fudan University Journal of Medical Sciences

基　　金：北京康华中西医发展基金会妇科肿瘤专项研究基金(KH-2021-LLZX-076)。

摘　　要：目的探讨上皮性卵巢癌(epithelial ovarian cancer,EOC)肿瘤细胞减灭术中行脾脏联合胰尾切除的安全性和疗效。方法选取2015年12月至2022年9月在复旦大学附属中山医院和中国科学技术大学附属第一医院(安徽省立医院)EOC肿瘤细胞减灭术中接受脾脏联合胰尾切除的患者共17例,回顾性分析患者的临床特点、手术信息、术后并发症及生存随访。结果17例患者包括13例初治和4例复发EOC患者。术前影像提示脾门转移的患者有11例(64.7%),术中发现6例脾门及胰尾肿瘤转移。术后脾窝放置负压引流管,监测引流液淀粉酶,引流管移除中位时间为8(3~12)天。术后4例患者发生生化漏(A级胰瘘),3例发生B级胰瘘,无C级胰瘘。2例行经皮穿刺引流后好转,其余持续引流、生长抑素、抗生素治疗后好转,无围手术期死亡,术后恢复至化疗中位时间为17.5(13~37)天。中位随访时间为14(4~64)个月,中位无进展生存期为10(5~32)个月。结论脾脏联合胰尾切除术在EOC肿瘤细胞减灭术中可行,通过适当的防治措施,术后并发症胰瘘可控。Objective To evaluate the safety and efficacy of splenectomy with distal pancreatectomy during cytoreductive surgery in epithelial ovarian cancer(EOC).Methods A total of 17 patients from Zhongshan Hospital,Fudan University and the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)received splenectomy with distal pancreatectomy during cytoreductive surgery in EOC were recruited.Their clinicopathological characteristics,postoperative complications and survival situation were retrospective analyzed.Results Of the 17 patients,there were 13 primary cases and 4 recurrent cases.Eleven cases(64.7%)had preoperative imaging finding with metastatic lesions in the splenic hilum,among whom 6 cases had distal pancreas metastasis during the operation.The drainage was placed in the splenic fossa for the measurement of amylase levels in drain fluid and was removed after 8(3-12)days.There were 4 patients had postoperative pancreatic fistula(POPF)of grade A,3 patients had POPF of grade B and no POPF of grade C occurred.The 2 patients with POPF of grade B improved after percutaneous drainage,and the rest recovered with somatostatin,antibiotic drugs and medicines without perioperative mortality.The interval between surgery to chemotherapy was 17.5(13-37)days.The median follow-up time was 14(4-64)months and the median progression-free survival was 10(5-32)months.Conclusion Splenectomy with distal pancreatectomy as part of cytoreduction surgery in EOC is needed for optimal resection,and the complication of pancreatic fistula could be managed conservatively.

关 键 词：上皮性卵巢癌(EOC) 肿瘤细胞减灭术 胰尾切除 脾脏切除 

分 类 号：R737.31[医药卫生—肿瘤]